Arizona's Coconino County, near Flagstaff, has reported a pneumonic plague death, its first since 2007. The Arizona resident, who suffered a severe lung infection caused by the Yersinia pestis bacterium, had no connection to a prairie dog die-off in the Townsend Winona area, northeast of Flagstaff, officials said. 

This is the first plague death reported in Coconino County since 2007, when a person who had an interaction with a dead animal was infected with the disease.

Risk to public is low

County officials said no further details about the recent death will be released out of respect for the person and his or her family. Officials also said the overall risk to the public is low. According to the Centers for Disease Control and Prevention, only about seven people in the United States are sickened with plague annually. 

Yersinia pestis can be transmitted to animals through bites from infected fleas, but the risk of human-to-human transmission is very low. The last documented human-to-human transmission in the United States occurs in 1924. 

If detected early, plague can be treated effectively with antibiotics. 

A review of clinical Aspergillus fumigatus isolates collected over nearly 30 years from Dutch hospitals shows rising resistance to triazole antifungals, researchers reported last week in The Lancet Microbe.

For the study, a team of Chinese and Dutch scientists conducted genomic and phenotypic screening of more than 12,000 A fumigatus isolates from Dutch hospitals from 1994 through 2022 for resistance to triazole therapy. 

Triazoles are the first-line recommended treatment for invasive aspergillosis, which is caused by inhalation of spores produced by the environmental fungus and can lead to severe lung infections in at-risk populations, including those with severe influenza and COVID-19. The researchers were looking for signature genetic mutations that confer resistance to triazoles and have emerged in samples of A fumigatus collected from plants and soil in response to widespread use of agricultural fungicides.

Of the 12,679 isolates screened, 1,979 (15.6%) harbored cyp15A triazole resistance mutations, predominantly caused by tandem repeat (TR) of 34 bases (TR₃₄/Leu98His) and 46 bases (TR₄₆/Tyr121Phe/Thr289Ala) in the promoter region, which correspond with signature triazole resistance phenotypes. 

Phenotype and genotype variations were observed in 325 (17.2%) triazole-resistant isolates harboring a TR-resistance mechanism, including 12 cyp51A genotype variants. Triazole phenotype and genotype variations appeared to be more frequent in isolates collected since 2017 compared with those collected from 1994 to 2004.

A 'major clinical challenge'

A review of 59 patients with confirmed or probable invasive aspergillosis infections found that 13 (22%) had triazole-resistant cases, of which three were caused by genotype variants. Mixed-genotype infection was observed in 11 (84.6%) of 13 triazole-resistant patients, and the number of antifungal treatment switches in those patients was much higher than in those with triazole-susceptible infections.

"Triazole resistance variation and mixed A fumigatus genotypes represent a major challenge in clinical management of Aspergillus diseases because current molecular diagnostic tools will increasingly fail to predict the resistance phenotype, underscoring the need for improved detection methods," the study authors wrote.

The authors add that the findings highlight the need for international One Health resistance surveillance programs for A fumigatus.

• Following a safety review following reports of serious side effects, mainly in older people, the European Medicines Agency announced on July 11 that it has lifted a restriction it recommended in early May. Its safety committee reviewed 28 reports of serious side effects following vaccination with Ixchiq, made by Valneva. Most involved people ages 65 and older and those with multiple chronic or uncontrolled underlying medical conditions. Three cases were fatal. The side effects worsened patients’ medical condition or a deterioration in general health. Many side effects were similar chikungunya symptoms, which are typically mild but can be serious in 2 in 100 patients. The group also looked at encephalitis reports, noting that frequency is not known. They said the vaccine is effective at triggering antibodies against chikungunya, which may benefit older people who are at risk of severe complications from the disease. They note that since Ixchiq is a live-virus vaccine, it is already contraindicated for people who have weakened immune systems.
• Testing at India’s National Institute of Virology has confirmed a third recent Nipah virus case from India’s Kerla state, which involves a 58-year-old man from Palakkad district who had been hospitalized with a fever and died from his illness, The Hindu reported. The patient is from the same district as a patient whose illness was confirmed. Health officials have identified 543 contacts, including 46 who were exposed to the man who died. Nipah virus is spread by fruit bats and can be transmitted between people. People can also contract the virus from drinking palm sap or eating fruit contaminated with bat urine, droppings, or saliva. The disease has a high case-fatality rate, and currently there are no specific treatments or vaccine, though trials are under way. Kerala state has been India’s Nipah virus hot spot over the past few years, with six cases reported over the past year.
• GSK today announced that the US Food and Drug Administration (FDA) has accepted its application to review an expanded age indication for Arexvy, its respiratory syncytial virus (RSV) vaccine for use in people ages 12 to 49 years old who are at increased risk of complications from the disease. The submission is based on results from a phase 3b clinical trial data showing promising immune response and safety data. An FDA decision is expected in the first quarter of 2026.